Provider Demographics
NPI:1073516662
Name:BUCKHEAD DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BUCKHEAD DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIPAA COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-266-1300
Mailing Address - Street 1:3340 PEACHTREE RD NE
Mailing Address - Street 2:STE 1685
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1012
Mailing Address - Country:US
Mailing Address - Phone:404-266-1300
Mailing Address - Fax:404-365-8526
Practice Address - Street 1:3340 PEACHTREE RD NE
Practice Address - Street 2:STE 1685
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1012
Practice Address - Country:US
Practice Address - Phone:404-266-1300
Practice Address - Fax:404-365-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA8628 GA10187GA92321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty